Nonalcoholic Steatohepatitis – Unmet Need – Detailed, Expanded Analysis (US & EU)

NASH has the potential to be a large and lucrative therapy market owing to the prevalence of the disease and the lack of approved agents. Patients with NASH are at risk of liver fibrosis, cardiovascular disease, and cancer. Currently, physicians are limited to off-label therapies that have limited evidence to support prescribing. Consequently, there is a pressing need for new, effective drug treatments. In this report, hepatologists reveal what attributes drive their prescribing and what they are looking for in terms of efficacy, safety, and delivery from future treatments. Using the Target Product Profile (TPP) simulator, we can establish physicians’ preference for emerging drugs and assess if these drugs can capitalize on the untapped NASH space.

QUESTIONS ANSWERED

  • What are the treatment drivers and goals for NASH?
  • What drug attributes are key influences, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key treatment drivers and goals for NASH?
  • What are the prevailing areas of unmet need and opportunity in NASH?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. and European hepatologists and gastroenterologists for a hypothetical new NASH drug?

PRODUCT DESCRIPTION

Provides quantitative insight into U.S. and European physician perceptions of key treatment drivers and goals and the current level of unmet need for a specific disease. Commercial opportunities are analyzed, and the extent to which emerging therapies may capitalize on these opportunities is evaluated.

Markets covered: United States, United Kingdom, France, Germany

Primary research: Survey of 60 U.S. and 33 European hepatologists and gastroenterologists fielded in March 2022

Key companies: Intercept Pharmaceuticals, AstraZeneca, Johnson and Johnson, Eli Lilly, GlaxoSmithKline

Key drugs: Ocaliva (obeticholic acid), pioglitazone, vitamin E, metformin, ursodeoxycholic acid, statins, SGLT-2 inhibitors, GLP-1 receptor agonists

Table of contents

  • Nonalcoholic Steatohepatitis - Unmet Need - Detailed, Expanded Analysis (US & EU)
    • Executive summary
      • Unmet Need - NASH - Executive Summary - July 2022
    • Introduction
      • Overview
      • Methodology
      • Rationale for treatment drivers and goals selection
        • Rationale for drug selection
          • Products for NASH and rationale for drug selection
      • Treatment drivers and goals
        • Key findings: attribute importance
        • Relative importance of efficacy, safety and tolerability, convenience of administration, and nonclinical attributes to surveyed hepatologists' and gastroenterologists' prescribing decisions in NASH
        • Importance of efficacy attributes to prescribing decisions in NASH: United States
        • Importance of efficacy attributes to prescribing decisions in NASH: Europe
        • Importance of safety and tolerability attributes to prescribing decisions in NASH: United States
        • Importance of safety and tolerability attributes to prescribing decisions in NASH: Europe
        • Importance of convenience of administration attributes to prescribing decisions in NASH: United States
        • Importance of convenience of administration attributes to prescribing decisions in NASH: Europe
        • Key findings: stated vs. derived importance
        • Stated vs. derived importance of key efficacy, safety and tolerability, convenience of administration, and nonclinical attributes to prescribing decisions in NASH: United States
        • Stated vs. derived importance of key efficacy, safety and tolerability, convenience of administration, and nonclinical attributes to prescribing decisions in NASH: Europe
      • Product performance against treatment drivers and goals
        • Key findings
        • Overall performance of key therapies for NASH: United States
        • Overall performance of key therapies for NASH: Europe
        • Mean overall performance of key therapies for NASH: United States and Europe
        • Relative performance of key therapies for NASH across select efficacy attributes: United States
        • Relative performance of key therapies for NASH across select efficacy attributes: Europe
        • Relative performance of key therapies for NASH across select safety and tolerability attributes: United States
        • Relative performance of key therapies for NASH across select safety and tolerability attributes: Europe
        • Relative performance of key therapies for NASH across select convenience of administration attributes: United States
        • Relative performance of key therapies for NASH across select convenience of administration attributes: Europe
      • Assessment of unmet need
        • Key findings: unmet need in NASH
        • Surveyed hepatologists' and gastroenterologists' satisfaction with the performance of key therapies for NASH on efficacy, safety and tolerability, convenience of administration, and nonclinical factors: United States
        • Surveyed hepatologists' and gastroenterologists' satisfaction with the performance of key therapies for NASH on efficacy, safety and tolerability, convenience of administration, and nonclinical factors: Europe
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need across key efficacy attributes in NASH: United States
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need across key efficacy attributes in NASH: Europe
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need across key safety and tolerability attributes in NASH: United States
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need across key safety and tolerability attributes in NASH: Europe
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need across key convenience of administration attributes in NASH: United States
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need across key convenience of administration attributes in NASH: Europe
        • Key findings: unmet need in NASH and related indications
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need in NASH and related indications: United States
        • Surveyed hepatologists' and gastroenterologists' ascribed level of unmet need in NASH and related indications: Europe
      • Opportunity analysis
        • Areas of opportunity in the NASH market and emerging therapy insights
          • Opportunity: a novel agent that demonstrates efficacy in improving hepatic fibrosis
          • Opportunity: a novel agent that reduces hepatic inflammation and steatosis
          • Opportunity: a novel agent that reduces insulin resistance
          • Opportunity: a novel agent that is safe and tolerable
      • Target product profiles
        • Assessing drug development opportunities
        • Target product profile methodology
          • Attributes and attribute levels
        • Attribute importance and part-worth utilities
          • NASH target product profile: attribute importance
          • Improvement of u2265 1 stage of hepatic fibrosis
          • NASH resolution without worsening of hepatic fibrosis
          • Effect on risk of adverse liver-related outcomes
          • Effect on all-cause mortality
          • Discontinuation rate at 1 year due to treatment tolerability
          • Dosing burden
          • Price per patient per day
        • Conjoint analysis-based simulation of a market scenario
          • NASH market simulation: share of preference of target product profiles included in the market scenario
          • NASH market simulation: likelihood to prescribe target product profiles included in the market scenario
          • NASH market simulation: target product profiles included in the market scenario
      • Appendix
        • Key abbreviations
        • Bibliography

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